Table 1.
Use of FMD in cardiovascular and associated risk factor conditions.
| Author(s) | Year | Condition studied | Number of patients | Summary |
|---|---|---|---|---|
| Anderson et al. [72] | 1995 | Coronary artery disease (CAD) | 50 | Patients with CAD had worse FMD than those with normal coronary arteries (4.5 ± 4.6% versus 9.7 ± 8.1%, p<.02) |
| Anderson et al. [73] | 2000 | CAD | 80 | Quinapril associated with significant improvement in FMD (1.8 ± 1%, p<.02). No change observed with Losartan (0.8 ± 1.1%, p=.57), Amlodipine (0.3 ± 0.9%, p=.97) or Enalapril (−0.2 ± 0.8%, p = .84) |
| Borschel et al. [53] | 2019 | Atrial fibrillation (AF) | 466 AF versus 14,330 non-AF | Decreased FMD in patients with AF observed but this was not statistically significant |
| Celermajer et al. [68] | 1992 | Atherosclerosis [Smoking, familial hypercholesterolaemia (FH), CAD] | 50 controls versus 20 cigarette smokers versus 10 FH children versus 20 CAD | FMD was reduced or absent in smokers (4%), FH children (0%) and adults with CAD (0%) when compared with controls (11%) (p<.001) |
| Celermajer et al. [74] | 1993 | Atherosclerosis (smoking) | 80 controls versus 80 current smokers versus 40 ex-smokers | FMD was impaired or absent in smokers compared to controls (4 ± 3.9% versus 10 ± 3.3%, p<.0001). FMD was inversely related to lifetime dose smoked |
| Chambers et al. [75] | 1999 | Hyperhomocysteinemia | 17 | Inverse linear relationship between homocysteine concentration and FMD (p<.001) |
| Clarkson et al. [76] | 1997 | Family history of CAD | 50 first-degree relatives versus 50 controls | FMD was impaired in family history group compared to control group (4.9 ± 4.6% versus 8.3 ± 3.5%, p<.005) |
| Dupuis et al. [77] | 1999 | CAD, Hypercholesterolaemia | 30 (Pravastatin) versus 30 (placebo) | FMD increased with Pravastatin (4.93 ± 0.81% to 7.0 ± 0.79%, p=.02). FMD was unchanged with placebo (5.43 ± 0.74% to 5.84 ± 0.81%) |
| Felmeden et al. [78] | 2003 | Hypertension (HTN) | 76 HTN versus 48 controls | FMD lower in HTN patients compared with control (4.8 ± 1.3% versus 8.6 ± 2.2%, p<.001). After intensified hypertensive treatment, FMD improved (4.8 ± 1.3% (baseline) to 7.3 ± 1.7%, p<.001) |
| Freestone et al. [52] | 2008 | AF | 40 AF versus 26 NSR | Worse FMD in AF patients than NSR patients (0.0 versus 8.9%, p<.0001) |
| Gerhard et al. [79] | 1998 | Post menopause, hypercholesterolaemia | 17 | Oestradiol therapy improved FMD compared with placebo (11.1 ± 1.0% versus 4.7 ± 0.6%, p<.001). Modest decrease in total and LDL cholesterol with oestradiol |
| Gokce et al. [80] | 2002 | CAD | 187 | 45 patients with cardiovascular event. FMD independent predictor of events (4.9 ± 3.1% versus 7.3 ± 5%; p<.001) |
| Gokce et al. [61] | 2003 | Peripheral arterial disease (PAD) | 199 | Worse FMD in patients ending up having a cardiovascular event (cardiac death, myocardial infarction, unstable angina, stroke) (4.4 ± 2.8% versus 7.0 ± 4.9%, p<.0001) |
| Hornig et al. [81] | 1998 | Heart failure | 30 | Quinaprilat improved FMD by 40% (10.2 ± 0.6% versus 6.9 ± 0.6%; p<.01) whereas enalaprilat had no effect |
| Iiyama et al. [82] | 1996 | Hypertension | 13 HTN versus 13 controls | FMD found to be less in patients with HTN than controls (13.1 ± 1.6% versus 18.5 ± 1.9%, p<.05) |
| Komatsu et al. [54] | 2018 | AF | 184 paroxysmal AF (PAF) versus 53 chronic AF versus 79 sinus rhythm controls | FMD was 5.4 ± 2.6% in PAF patients versus 4.3 ± 2.1% in chronic AF versus 6.5 ± 3.5% in controls, which was significant (all, p<.05) |
| Lekakis et al. [83] | 1997 | Diabetes mellitus | 26 insulin-dependent diabetes mellitus (IDDM) without microalbuminuria versus 5 IDDM with microalbuminuria versus 26 controls | FMD was lower in patients with IDDM with and without microalbuminuria compared with controls (0.75 ± 2.5% versus 5.8 ± 7% versus 11 ± 7%, p=.003 and .01, respectively) |
| Lieberman et al. [84] | 1994 | Post menopause | 13 | FMD greater in patients receiving Oestradiol than placebo (13.5 versus 6.8%, p<.05) |
| Mazaris et al. [55] | 2014 | AF | 35 PAF versus 117 permanent AF | Patients with permanent AF had impaired FMD compared to PAF (4.09 ± 1.67% versus 6.83 ± 1.38%, p<.001). Endothelial dysfunction associated with atrial remodelling in patients with AF and implicated in the progression from paroxysmal to permanent AF |
| Modena et al. [85] | 2002 | Hypertension | 400 | 47 patients with cardiovascular event. Majority of these had poor FMD response (7.1 ± 2.5% versus 13.9 ± 2.6%). FMD can be improved following 6 months of antihypertensive treatment |
| Neunteufl et al. [86] | 1997 | CAD | 44 (CAD) versus 30 (angina pectoris – non CAD) versus 14 controls | CAD patients showed markedly impaired FMD compared to non-CAD group and to control (5.7 ± 4.8% versus 12.6 ± 6.7% versus 15.7 ± 3.9%, p<.00001) |
| Neunteufl et al. [87] | 2000 | CAD | 73 | 27 patients with cardiovascular event. FMD < 10% predictive of events |
| O’Neal et al. [88] | 2014 | AF | 2936 | Smaller brachial FMD values associated with higher rates of AF. Each 1SD increase in %FMD values (SD, 2.8%) associated with less incident AF (hazard ratio 0.84; 95% CI 0.70–0.99) |
| Perri et al. [89] | 2015 | AF | 514 | Patients who experienced a cardiovascular event showed significantly reduced FMD compared to those who did not (3.06% [IQR 0.00–6.00] versus 4.67% [IQR 1.58–8.22], p=.027) |
| Polovina et al. [56] | 2013 | AF | 38 AF versus 28 controls | Median FMD significantly lower in AF patients compared to control (5.0% [IQR 2.87–7.50%] versus 8.85% [IQR 5.80–12.50%], p<.001) |
| Rossi et al. [62] | 2008 | Post menopause | 2264 | FMD ≤ 4.5% associated with a greater cardiovascular event rate compared with FMD > 4.5% |
| Schachinger et al. [90] | 2000 | CAD | 147 | 28 patients with cardiovascular event. FMD independent predictor of events |
| Shaikh et al. [91] | 2016 | AF | 3921 | Lower FMD associated with an increased risk of incident AF (hazard ratio: 0.79, 95% CI 0.63–0.99, p=.04) |
| Shaposhnikova et al. [92] | 2017 | AF | 29 PAF versus 32 persistent AF versus 35 permanent AF | Progressive deterioration of FMD observed from PAF (7.96 ± 1.22%) to persistent AF (6.35 ± 1.18%) to permanent AF (4.81 ± 1.15%) (p = .001). Inverse correlation between permanent AF and FMD (r= −0.061, 95% CI 0.032–0.081) even after adjustment for comorbid diseases |
| Siasos et al. [93] | 2015 | AF | 65 (30 PAF and 35 Permanent AF) | Duration of AF inversely associated with FMD (rho= −0.058, p=.006). This was even after adjustment for confounders |
| Simons et al. [94] | 1998 | Hypercholesterolaemia | 32 | Median FMD improved compared to baseline with atorvastatin (2.2% → 5.5%) and simvastatin + cholestyramine therapy (1.8% → 4.5%) (p<.01 for both). FMD at baseline correlated with HDL cholesterol (r = 0.49, p<.01). Change in FMD was inversely correlated with baseline FMD (r= −0.54, p<.001) |
| Ulgen et al. [57] | 2014 | AF | 40 PAF versus 40 controls | FMD in AF group was significantly lower relative to control group (5.27 versus 6.65,p = .001) |
| Woo et al. [95] | 2002 | Hyperhomocysteinemia | 17 | Folic acid supplementation significantly improved FMD compared to placebo (7.4 ± 2% versus 8.9 ± 1.5%, p<.0001) |